Denti Matteo, Tornese Davide, Melegati Gianluca, Schonhuber Herbert, Quaglia Alessandro, Volpi Piero
Knee Surgery and Sports Traumatology Unit, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Center for Sports Rehabilitation, IRCCS Galeazzi Orthopedics Institute, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2015 Oct;23(10):2853-8. doi: 10.1007/s00167-015-3764-8. Epub 2015 Aug 30.
Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot.
Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale.
The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in the healthy knee and 65 % in group A and 64.9 % in group B in the operated knee (angular velocity 180°/s). Lysholm outcome was 93.9 ± 3.9 in group A and 89.1 ± 7.6 in group B (n.s). Cincinnati score was 89.6 ± 7.3 in group A and 91.0 ± 6.9 in group B (p = 0.791). IKDC results were group A in six patients (60 %), group B in three patients (30 %) and group C in one patient (10 %) in the allograft group and group A in seven patients (70 %) and group B in three patients (30 %) for autologous group.
The results of this study suggest that one-stage arthroscopic bicruciate ligament reconstruction can restore good knee joint function. Surgical treatment should be followed by a comprehensive rehabilitation programme with specific goals, objectives and strategies, including pain management and assessment of progress in recovery of joint function and perception of knee stability.
Retrospective case series, Level IV.
前交叉韧带（ACL）和后交叉韧带（PCL）的多韧带损伤虽不常见，但会使人虚弱。合并韧带损伤的患者通常抱怨膝关节疼痛、虚弱不稳，这限制了他们的运动和日常活动。本回顾性研究的目的是评估慢性ACL和PCL缺失且接受同期单阶段关节镜下中央枢轴重建的患者的功能和临床结果。
回顾性分析连续20例慢性ACL和PCL缺失且接受同期单阶段关节镜下中央枢轴重建患者的病历。所有患者均接受同种异体移植物（A组）或半腱肌-股薄肌移植物进行ACL修复，以及髌腱-胫骨骨移植物进行PCL修复（B组）。在24个月随访的初始随访期后，通过在60°/秒和180°/秒下进行同心等速膝关节伸肌-屈肌测试来评估功能结果。次要目的是通过使用国际膝关节文献委员会（IKDC）膝关节韧带评估表、Lysholm膝关节评分量表和辛辛那提膝关节评分量表来比较长期临床恢复情况。
与健侧膝关节相比，A组手术侧股四头肌力量平均 deficit为13.5%，B组为15%（角速度60°/秒），A组为13.5%，B组为9.4%（角速度180°/秒）。与健侧膝关节相比，A组手术侧屈肌力量平均 deficit为10.4%，B组为12.3%（角速度60°/秒），A组为12.2%，B组为9%（角速度180°/秒）。健侧膝关节中，A组和B组的屈肌-股四头肌比率分别为49.4%和48.8%，手术侧膝关节中，A组和B组分别为53.2%和53.8%（角速度60°/秒）；健侧膝关节中，A组和B组分别为63.9%和60.7%，手术侧膝关节中，A组和B组分别为65%和64.9%（角速度180°/秒）。Lysholm结果在A组为93.9±3.9，B组为89.1±7.6（无显著差异）。辛辛那提评分在A组为89.6±7.3，B组为91.0±6.9（p = 0.791）。在同种异体移植物组中，IKDC结果为A组6例患者（60%），B组3例患者（30%），C组1例患者（10%）；自体移植物组中，A组7例患者（70%），B组3例患者（30%）。
本研究结果表明，一期关节镜下双交叉韧带重建可恢复良好的膝关节功能。手术治疗后应进行全面的康复计划，包括疼痛管理以及对关节功能恢复和膝关节稳定性感知进展的评估，该计划具有特定的目标、目的和策略。
回顾性病例系列，IV级。
